Photo-Therapeutic Keratectomy - Laser Eye Surgery Guide

Photo-Therapeutic Keratectomy (PTK) is a type of eye surgery used to treat diseases of the corneal surface as well as to treat scars. Examples of diseases that can be treated by PTK are epithelial erosion syndrome and corneal dystrophy. You should note that this surgical procedure is not used to improve vision and so if you are considering undergoing just PTK so you no longer have to wear glasses or contact lenses, then you should think again. If this is your desire, it is possible for you to undergo a combined PTK-PRK procedure.

What makes PTK different from PRK, LASEK and LASIK?

The key factor that defines PTK is that it provides medical benefits rather than just improving eyesight. The problems that PTK can help with are associated with diseases of the cornea whereas PRK, LASEK and LASIK are more related to correcting refractive issues.

So when comparing PTK with the three other procedures, it is clear that PTK is more medically beneficial compared to cosmetically beneficial as seen with the others.

An example of a disorder that PTK can resolve is corneal dystrophy whereas examples of issues that can be sorted with PRK, LASIK or LASEK include presbyopia and astigmatism.

Who is a suitable candidate for PTK?

A significant factor that would make you suitable for undergoing PTK is if you suffer from either corneal damage or surface disease. Examples of such issues, which would increase your suitability for the surgery include:

• Corneal dystrophy
• Persistent epithelial erosion syndrome
• Scarring of the cornea

Other components that contribute to determining suitability for PTK include good general health and realistic expectations in terms of the outcome.

If you also wish to improve your eyesight then PTK may be the ideal option for you. The procedure can be combined with laser eye surgeries such as PRK, LASIK or LASEK. If this is something you wish to consider then you should approach your surgeon for further advice.

Alternatives to PTK

If your surgeon does not consider you a suitable candidate for PTK then you do have other options. One of these options is a cornea transplant and the other is manual scraping.

A cornea transplant involves your surgeon removing the damaged part of your cornea and replacing it with a healthy cornea. It is sometimes referred to as a penetrating keratoplasty or PK. This cornea is generally human and is taken from an eye bank close to the clinic. The transplant is frequently done so you eye can regain the ability to focus efficiently.

Manual scraping (or cornea scraping) is a procedure encompassing your surgeon physically scraping away the section of cornea that has been subjected to damage or disease. An example when manual scraping may be employed is if you have a corneal ulcer.

Are there any risks associated with PTK?

As with all forms of surgery, PTK does carry some potential risks, however you should note that most often the surgery is performed safely and complication-free.

The PTK procedure is permanent and you should always consider any potential risks, no matter how small or rare, before committing yourself to the surgery. In terms of PTK the potential risks and complications can include:

• Halos
• Glare
• Starbursts
• Sensitivity to light

For most people, the above occurrences are temporary and mild, however a minority of patients do suffer permanently. During your consultation, your surgeon will give further insight to these risks and will be able to incorporate the possibility when determining how suitable you are for PTK.

What benefits will result from PTK?

Essentially, the benefit you will experience will be the resolution of your corneal damage or disease. Other benefits associated with PTK include a smoother, clearer cornea as well as better vision. The vision aspect can be further improved if you combine PTK with other procedures such as PRK, LASIK or LASEK.

Your PTK consultation

Prior to your surgery you will be required to attend a consultation. Here you will be given a chance to ask any questions you desire. If you wish to see examples of questions that may benefit you when deciding if PTK is right for you, then please visit our section, 'Laser Eye Surgery: General FAQs'. These questions are broad as they are related to all types of laser eye surgery so you may wish to make them more specific. Examples of such questions include:

• Exactly what corneal diseases can be resolved using PTK?
• Is it possible to combine the PTK procedure with other laser eye procedures to improve my vision and what additional risks may this carry?
• Will be eyesight be affected by the PTK surgery? If so, how?

You may also wish to consider approaching a number of different surgeons with the same list of questions. You can then select the surgeon that gave you the most satisfying answers, which will increase the amount of trust you have in them.

By the end of your consultation, it should be possible for your surgeon to provide you will a quote so you can sort out the money aspect of your procedure. The cost of PTK depends on the clinic and surgeon but often it is approximately £900 per eye.

Is PTK available on the NHS?

The NHS makes a point of only providing funding for surgical procedures that will be medically beneficial and are required by the person concerned. The NHS will have to assess, in detail, the benefits the procedure will have for you before making a decision.

Just because PTK is a medical procedure, it does not guarantee you NHS funding. Therefore, it is important to determine exactly whether or not you can obtain funding or personally afford the procedure before committing to it.

To get advice about NHS funding, you should talk to your doctor. If they feel that the procedure will benefit you physically, mentally or socially in a significant way then it is possible that they will refer your case for NHS funding. This will result in you being referred to a suitable clinic.

Will my private medical insurance cover PTK?

It is not clear to say whether your private medical insurance will cover PTK, as it is entirely dependent on your policy. You should check over your policy in detail and if you are still unsure, contact your insurance company.

The PTK procedure

Before any surgery is carried out, your surgeon will begin by attaching a special clip to hold your eyelids open throughout the procedure. Once this is in place, your eyes and the surrounding area will be cleaned and numbing eye drops will be administered to make the procedure as comfortable as possible.

The next stage involves your surgeon removing the top layer of the cornea, known as the epithelium. This ensures that the excimer laser has full, uninhibited access to your cornea so it can be treated efficiently. The treatment by the laser is dependent on your condition; it may involve reshaping or an alternative corrective procedure.

Once this has been done, your surgeon will administer antibiotic eye drops. These are applied to try and prevent post-operative infections from occurring. To further protect the eye(s), a bandage lens will be positions on the eyes, which is effectively a contact lens that has been specifically designed for protection.

After the procedure: results and recovery

The results of the PTK procedure are permanent, which is often a significant benefit to most.

In the days following your procedure, you may notice some pain and/or discomfort. This can be managed with over-the-counter painkillers such as aspirin or paracetamol. This discomfort is normal and results from the epithelium healing. However, if you are at all concerned contact your clinic as soon as possible.

After your PTK surgery, you should relax for a few days to aid the healing and recovery process. It may be advised by your surgeon that you take some time off work and avoid straining your eyes with certain activities. If you have been prescribed any eye drops, it is important that you take them as frequently as advised by your surgeon.

During the recovery period, you should avoid touching or rubbing your eyes as this may lead to infection, a longer healing time or even damage. If you worried that you may accidently do this in your sleep, it may be worth obtaining and wearing a plastic eye patch overnight.

In the few days following your procedure, you may notice that your eyesight is not very clear due to a level of haze or blurriness. This should ease over the coming days. Due to this, it is recommended that you do not drive until you regain your full eyesight. If the haze or blurriness does not subside, contact your surgeon or doctor.